Charles Lapp, M.D. has practiced in
North Carolina since 1978. In 1988, he joined Dr. Paul Cheney's CFIDS clinic
and in 1995, opened a CFS/FM consultation practice. His objective in lecturing
to patient groups is to review all the recognized therapies for CFIDS (CPS
and FM) and evaluate them for safety and efficacy. He uses "The Stepwise
Approach" to treatment: Education (letting the PWC know they're "not dying
and not crazy"), Activity ("the more you exert, the sicker you feel", "balance
light activity with bed rest", Nutrition, Vitamin and supplements, and
Specific Symptomatic and Supportive Therapies. These are essential, he
feels, as "steps to recovery," Dr. Lapp feels, with time, nature will heal
every PWC.

Under activity, Dr. Lapp stressed the
importance of good posture since poor posture "leads to nuchal or bitemporal
headaches, tension at (the) neck and shoulders, and atypical breathing."
Most PWCs breath through the chest and must learn good posture and abdominal
breathing.

Stretching exercises he advocates are
simple stretches such as "cherry picking" (pretend you're reaching up,
alternating arms, to pick cherries from a high branch), head rolls, leg
stretching, and shoulder shrugs. Also recommended is yoga or tai chi.

Physical modalities include cool to
hot poets where each is used alternately on the painful area, spray and
stretch using cool water for tightened muscles as you stretch them, massage
(he noted that cranial/sacral therapy was "particularly good"), and a good
acupuncturist (if, after 5 or 6 sessions, it doesn't help, find another
acupuncturist). TENS, ultrasound, and cold lasers can also benefit painful
muscles,

Hydrotherapy, a vertical floatation
therapy that essentially cools your core temperature and increases blood
volume, is helpful. This was introduced by Dr. Cheney. PWCs can also benefit
from soaking in a bathtub for 15 minutes

two or three times weekly, "but get
a thermometer and get the temperature up to about 90 degrees, which is
still less than your body's temperature. CFIDS "is a vertical illness,"
Dr. Lapp said, where the PWC feels worse when upright. "Hot showers make
you feel weaker because they up-regulate the cytokines," so avoid hot,
hot showers.

Interval exercise is low level exercise.
"If you overdo, you'll relapse." Dr. Lapp cited a study by Dr. Natelson's
research team and said, "I highly recommend low level exercise" where the
PWC exercises for 3 minutes or so and then rests for the same amount of
time and tries to slowly increase the time. Using weights or walking on
a treadmill are two examples of low level exercise.

Nutrition includes a prudent carbohydrate-based
diet with fresh fruit and vegetables. The light meals should always avoid
sugar, coHeine, alcohol, Nutrasweet, and tobacco. Some may find it necessary
to avoid dairy and/or wheat. Avoid milk, ice cream, and cheese for five
days to test for this. "If that doesn't work," he said, "try low gluten
for five days."

Dr. Lapp has found vitamin and mineral
deficiencies differ with every PWC and change often even with each individual
PWC. He advocates a high dose of vitamin B12 that is 12X the normal dose
(i.e. 2 to 3,000 mg. weekly) for a few months to see if that helps. CO-Enzyme
Q10 can help 10-15% and a good multivitamin with minerols should be taken.
Omega-3 and -6 fatty acids interfere with the inflammatory process "and
can help take the 'edge oR pain.'" Amino acids often help and can be tried
every few months using the least expensive mixture you can find,

Turning to symptomatic therapy, Dr.
Lapp said, "sleep is the most important one to address." One of the best
things that he's found is a low dose of doxepin (about 10 mg.) along with
Klonopin (0.5). He's also found 50 mg. of Trazadone nightly can help if
there's intermittent wakening. If you don't have severe problems sleeping,
try valerian root, Excedrin PM, or Tylenol PM. Melatonin (3-5 mg.) can
be helpful, but not for children with CFIDS. Combine melatonin with light
therapy by getting as much light as possible for 3 or 4 hours when you
first awaken. Melatonin is also helpful trying to readjust your body clock.
tf none of these work, he turns to hynotics that are related to Valium

Therapy for central activation involves
trying to increase seratonin levels. He suggest SSRls, Prozac, Zotoft,
Paxil, or dopamine agonists such as Weltbutrin. To control headaches which
tend to be pressure-like, he tries Diamox (125-500 mg. one or two times
daily) to release excess fluid from the broin. If this doesn't help, Dr.
Lapp tries calcium channel blockers. For migraines, he tries Esgic, Fiorenal,
Midrin, and lidocaine or DHEA sprays for the nose.

Pain (myalgias and arthralgias) ore
addressed with NSAIDS, analgesics, Ultram (a non-narcotic analgesic), and
magnesium sulfate injections one to two times weekly to address the "searing
ache" he calls "fibropain." He's also an advocate of the diet treatment
"Phen-Fen" (lonamin and Pondiman), which works particularly well for dieting
and reduces the pain of FM. He's used Oxytocin in pregnant women which
increases blood flow and also helps with cognition and vision. As a last
resort, he uses IV Lidocaine and Katamine.

"Would you believe," asks Dr. Lapp,
"thot there is one treatment, currently available, that has withstood the
test of peer reviews That is fomiliar to most practicing physicians, inexpensive,
safe and easy to take, and works in 25 to 50% of cases' No, it's not Ampligen....not
even six weeks in Maui, but just salt therapy! When the PWC stands, they
get a false signal to the brain to release more epinephrine, so you get
less blood and feel worse. Some actually faint!" This is known as NMH (neurally
mediated hypotension) that affects most (or all?) PWCs. Volume expansion
and an adrenergic blockade is used: water ( a lot! ), 2-6 grams of salt
(a gram is about a teaspoon), and Florinef, a beta blocker, or disopyramide.
He prescribes Norvace, but if you have normal or high blood pressure, be
carefull.

Under "New, unconventional, or investigational,"
Dr. Lapp includes IV Gamma Globulin, which he reserves for the very, very
ill. Kutapressin is an extract of pig's liver that works as an antiviral
and immune modulator and helps up to 75% with a 30% chance of full recovery.
The shots are expensive, however, and they hurt! Ampligen still has yet
to prove itself in tests, but he is anxious to be an investigator for this
drug. Amphetamines are also in this category such as low doses of Ritilin,
the lonomin of Phen-Fen, and Dextroamphetamines. One of these last is Cylert.
These are used because most PWCs hove stow brain waves. When they are wide
awake, the brain still acts like it's asleep, so the above con give o PWC
energy and help them to think clearly. The Ritalin is used in smaller (1/3)
doses than the dose usually used for ADD (attention deficit disorder).
Antibiotics are also under this category and are just being studied.

Preventative care includes avoiding
hot baths and sunbathing, having a bone density test (DEXA, a bone scan)
if you are at risk for osteoporosis, manage your cholesterol, and have
an annual examination that documents your progression or regression, reviews
medications, and lab tests that include a CBC (complete blood count), chemistry,
ESR, TFT, and UA since thyroid problems tend to be common in PWCs. If you've
had flu shots with no ill effects, then have one! However, Dr. Lapp did
a study on them with PWCs at Duke University and found that many patients
don't convert, so the shot does them no good and mony relapse from the
shot, "so you get an adverse effect and no benefit" Dental check-ups are
also part of preventative care since PWCs tend to have dry eyes and mouth.
This leads to acidity in the mouth. Dr. Lapp suggests using bicarbonate
(baking soda) based toothpaste. Perpetuating factors that should be addressed
are psychological problems, allergies, and asthma. Stressors such os family
dysfunction, financial pressures, and disability issues should try to be
resolved. Treat reactive depression, avoid allergens or toke allergy shots,
and treat yeast infections aggressively. Although yeast is not a causal
factor, PWCs are prone to severe yeast infections which worsen their CFIDS.
Take a prescribed oral medication for yeast infections because topical
won't help.

Addressing alternative therapies, Dr.
Lapp says some hove scientific merit, are not considered risky, but controlled
studies ore either lacking or conflicted. Those that have merit are acupuncture,
massage therapy, and chiropractic. Others are:

Vitamin B12

L-lysine

Anti-candida therapy

Amino acid supplements

Garlic

Pyridocal-5-phosphate

Sylimarin (milk thistle)

Neuromuscular therapy chiropractic

CoQ10

Melatonin

EPO/EPA (fatty acids)

Echinacea

Valerian root

L-or reduced-glutathione

Acupuncture

DHEA

Proanthrocyanidin (pine or grape)

Vitamin C

Gaufenisin

N-acetyl Sistine

Massage therapy

The list of therapies that have
no strong scientific support or benefit but are probably not risky include
the following:

Gingko biloba

St. John's Wort

Thymus extract

Homeopathy

Shitake mushroom extract

Cat's Clow

Essiac tea

Magnetic therapy

Quercetin

Adrenal extract

Blue Green Algae

Aroma therapy

Ones to avoid that could be risky include
the following:

Peroxide infusions

Ephedra (false energy)

CaReine (false energy)

Chelation therapy Gotu Kola (false energy)

Mushroom or fungus tea

Germanium

Ma huang (false energy)

Enemas

PWCs may request a hand-out of
an explanation of hydrotherapy or an outline of this treatment perspective
by writing to:

Physicians treating PWCs may call
Dr. Lapp with questions. His clinic will not accept Medicaid or Medicare
patients and not all treatments will be covered by insurance. Dr. Lapp
said, "Only 1/3 get reimbursement."

Dr. Lapp's treatments have been culled
from many experts, whom he holds in high regard, including Drs. Jay Goldstein,
David Bell, and Paul Cheney. He calls Dr. Goldstein, "A great guy. He probably
has done as much for CFS as anyone. He has lots of good treatments." Dr.
Lapp is currently involved in 14 clinical trials including one addressing
pregnancy and CFIDS.